<div class="row-fluid sortable">
			<div class="box span12">
				<div class="box-header well" data-original-title>
					<h2 id="action-title">Perubahan Stok Agen</h2><div class="box-icon">
					<a href="#" class="btn btn-minimize btn-round"><i class="icon-chevron-up"></i></a>
			</div>
				</div>
				<div class="box-content">
				<form id="form-edit-agen" method="post" action="<?php echo base_url();?>stok_agen/add_stok_agen">
				<table class="table">					
				<col width="10%">
				<col width="40%">
					<tbody>
						<tr>
							<td><label class="control-label">Agen</label></td>
							<td>
								<div class="controls">
								  <select data-rel="chosen" id="agen" name='agen'>
									<?php
										if($agen){
											foreach($agen->result_array() as $row){
												$row["NAMA_KOTA"] = str_replace("Kota","", $row["NAMA_KOTA"]);
												$row["NAMA_KOTA"] = str_replace("Kabupaten","", $row["NAMA_KOTA"]);
												echo "<option value='".$row["ID_TITIK_PASOK"]."'>".$row["NAMA_KOTA"].", ".$row["NAMA"]."</option>";
											}
										}
									?>
								  </select>
								</div>
							</td>
						</tr>
						<tr>
							<td><label class="control-label">Jenis Sapi</label></td>
							<td>
								<div class="controls">
								  <select data-rel="chosen" id="sapi" name='sapi'>
									<?php
										if($jenis_sapi){
											foreach($jenis_sapi->result_array() as $row){
												echo "<option value='".$row["ID_SAPI"]."'>".$row["NAMA"]."</option>";
											}
										}
									?>
								  </select>
								</div>
							</td>
						</tr>
						<tr>
							<td><label class="control-label">Alasan Perubahan</label></td>
							<td>
								<div class="controls">
								  <select data-rel="chosen" id="alasan" name='alasan'>
									<?php
										if($alasan){
											foreach($alasan->result_array() as $row){
												if($row["ID_ALASAN_PERUBAHAN"]!="4" && $row["ID_ALASAN_PERUBAHAN"]!="5" ){
													echo "<option value='".$row["ID_ALASAN_PERUBAHAN"]."'>".$row["NAMA_ALASAN_PERUBAHAN"]."</option>";
												}
											}
										}
									?>
								  </select>
								</div>
							</td>
						</tr>
						
						<tr>
							<td><label class="control-label">Jumlah</label></td>
							<td><input id="jumlah" type="text" name="jumlah"></input></td>
						</tr>
						<tr>
							<td><label class="control-label">Tanggal Kejadian</label></td>
							<td><input id="tanggal-kejadian" class="input-xmedium datepicker" type="text" name="tanggal_kejadian"></input></td>
						</tr>
						<tr>
							<td><label class="control-label">Catatan</label></td>
							<td><textarea id="catatan" name="catatan"></textarea></td>
						</tr>
						<input type="hidden" name="revisi" id="revisi" value="2" />
						<tr>
							<td></td>						
							<td>
								<input type="reset" class="btn" value="Reset"></input>
								<input id="button-panel" type="submit" class="btn" value="Simpan" /></input>
							</td>
						</tr>
					</tbody>
				</table>
			
				</form>	
			</div>
			</div><!--/span-->
				
		<div><!--/row-->
			